'All Aboriginal and Torres Strait Islander children should have access to the ASQ-TRAK': Shared vision of an implementation support model for the ASQ-TRAK developmental screener.

ISSUE ADDRESSED: The ASQ-TRAK, a strengths-based approach to developmental screening, has high acceptability and utility across varied Aboriginal and Torres Strait Islander contexts. While substantive knowledge translation has seen many services utilise ASQ-TRAK, we now need to move beyond distribution and support evidence-based scale-up to ensure access. Through a co-design approach, we aimed to (1) understand community partners' perspectives of barriers and enablers to ASQ-TRAK implementation and (2) develop an ASQ-TRAK implementation support model to inform scale-up. METHODS: The co-design process had four phases: (i) partnership development with five community partners (two Aboriginal Community Controlled Organisations); (ii) workshop planning and recruitment; (iii) co-design workshops; and (iv) analysis, draft model and feedback workshops. RESULTS: Seven co-design meetings and two feedback workshops with 41 stakeholders (17 were Aboriginal and Torres Strait Islander), identified seven key barriers and enablers, and a shared vision - all Aboriginal and Torres Strait Islander children and their families have access to the ASQ-TRAK. Implementation support model components agreed on were: (i) ASQ-TRAK training, (ii) ASQ-TRAK support, (iii) local implementation support, (iv) engagement and communications, (v) continuous quality improvement and (vi) coordination and partnerships. CONCLUSIONS: This implementation support model can inform ongoing processes necessary for sustainable ASQ-TRAK implementation nationally. This will transform the way services provide developmental care to Aboriginal and Torres Strait Islander children, ensuring access to high quality, culturally safe developmental care. SO WHAT?: Well-implemented developmental screening leads to more Aboriginal and Torres Strait Islander children receiving timely early childhood intervention services, improving developmental trajectories and optimising long-term health and wellbeing.

Supporting Aboriginal and Torres Strait Islander Families to Stay Together from the Start (SAFeST Start): Urgent call to action to address crisis in infant removals.

Reducing the rate of over-representation of Aboriginal and Torres Strait Islander children in out-of-home care (OOHC) is a key Closing the Gap target committed to by all Australian governments. Current strategies are failing. The "gap" is widening, with the rate of Aboriginal and Torres Strait Islander children in OOHC at 30 June 2020 being 11 times that of non-Indigenous children. Approximately, one in five Aboriginal and Torres Strait Islander children entering OOHC each year are younger than one year. These figures represent compounding intergenerational trauma and institutional harm to Aboriginal and Torres Strait Islander families and communities. This article outlines systemic failures to address the needs of Aboriginal and Torres Strait Islander parents during pregnancy and following birth, causing cumulative harm and trauma to families, communities and cultures. Major reform to child and family notification and service systems, and significant investment to address this crisis, is urgently needed. The Family Matters Building Blocks and five elements of the Aboriginal and Torres Strait Islander Child Placement Principle (Prevention, Participation, Partnership, Placement and Connection) provide a transformative foundation to address historical, institutional, well-being and socioeconomic drivers of current catastrophic trajectories. The time for action is now.

Maternal obesity prevention: The Health in Preconception, Pregnancy, and Postpartum Early- and Mid-Career Researcher Collective.

There is a clear impetus for researchers to facilitate cross-sector and interdisciplinary collaboration to achieve collective action for maternal obesity prevention. Building early- and mid-career researchers' capacity to sustainably develop collective action into the future is key. Therefore, the national Health in Preconception, Pregnancy, and Postpartum Early- and Mid-career Researcher Collective (HiPPP EMR-C) was formed. Here, we describe the aim, key goals and future directions of the HiPPP EMR-C. Guided by the Simplified Framework for Understanding Collective Action, we aim to build our capacity as researchers, form policy stakeholder relationships and focus on generating impact to optimise maternal and child health and well-being.

The value of library and information services in patient care: results of a multisite study.

OBJECTIVE: The research conducted a large-scale, multisite study on the value and impact of library and information services on patient care. METHODS: THE STUDY USED: (1) 2 initial focus groups of librarians; (2) a web-based survey of physicians, residents, and nurses at 56 library sites serving 118 hospitals; and (3) 24 follow-up telephone interviews. Survey respondents were asked to base their responses on a recent incident in which they had sought information for patient care. RESULTS: Of the 16,122 survey respondents, 3/4 said that they had definitely or probably handled aspects of the patient care situation differently as a result of the information. Among the reported changes were advice given to the patient (48%), diagnosis (25%), and choice of drugs (33%), other treatment (31%), and tests (23%). Almost all of the respondents (95%) said the information resulted in a better informed clinical decision. Respondents reported that the information allowed them to avoid the following adverse events: patient misunderstanding of the disease (23%), additional tests (19%), misdiagnosis (13%), adverse drug reactions (13%), medication errors (12%), and patient mortality (6%). CONCLUSIONS: Library and information resources were perceived as valuable, and the information obtained was seen as having an impact on patient care.

Identifying and dismantling racism in Australian perinatal settings: Reframing the narrative from a risk lens to intentionally prioritise connectedness and strengths in providing care to First Nations families.

INTRODUCTION: The perinatal period is a time when provision of responsive care offers a life course opportunity for positive change to improve health outcomes for mothers, infants and families. Australian perinatal systems carry the legacy of settler-colonialism, manifesting in racist events and interactions that First Nations parents encounter daily. OBJECTIVE: The dominance of a western risk lens, and conscious and unconscious bias in the child protection workforce, sustains disproportionately high numbers of First Nations infants being removed from their parents' care. Cascading medical interventions compound existing stressors and magnify health inequities for First Nations women. DESIGN: Critical discourse was informed by Indigenous ways of knowing, being and doing via targeted dialogue with a group of First Nations and non-Indigenous experts in Australian perinatal care who are co-authors on this paper. Dynamic discussion evolved from a series of yarning circles, supplemented by written exchanges and individual yarns as themes were consolidated. RESULTS: First Nations maternity services prioritise self-determination, partnership, strengths and communication and have demonstrated positive outcomes with, and high satisfaction from First Nations women. Mainstream perinatal settings could be significantly enhanced by embracing similar principles and models of care. CONCLUSIONS AND RELEVANCE: The Australian Anti-racism in Perinatal Practice (AAPP) Alliance calls for urgent transformations to Australian perinatal models of care whereby non-Indigenous health policy makers, managers and clinicians take a proactive role in identifying and redressing ethnocentrism, judgemental and culturally blind practices, reframing the risk narrative, embedding strength-based approaches and intentionally prioritising engagement and connectedness within service delivery.

Type-specific human papillomavirus DNA detected in atypical glandular cell Pap tests.

OBJECTIVES: To evaluate the presence of type-specific human papillomavirus (HPV) DNA in atypical glandular cells (AGCs) from cervical liquid-based cytology and to report the relationship between HPV types and cervical histological abnormalities. STUDY DESIGN: We used a nested multiplex polymerase chain reaction assay to test AGC Papanicolaou (Pap) tests for the presence of 14 high-risk (HR) HPV types. RESULTS: HR HPV types were detected in 33 of 161 AGC Pap tests (20.3%). Types 16 and/or 18 were detected in 13 samples (8%). Eight other HPV types were detected in 1-4 samples each. HPV-associated disease was diagnosed in 8 AGC cases (8%) with available histology results. The sensitivity and specificity of the HR HPV test were 87.5 and 90%, respectively, and the negative predictive value (NPV) was 99%. For a test that can isolate HPV types 16 and 18, the sensitivity and specificity were 62.5 and 100%, respectively, the positive predictive value (PPV) was 100% and the NPV was 97%. CONCLUSION: HPV 16 and 18 were the most common types detected in AGC Paps. We found high specificity, PPV and NPV with a test that can isolate these 2 HPV types. These results indicate a possible role for type-specific HPV testing in the management of AGC Pap tests.

Evaluating the Feasibility and Usability of the Disposable Intubation Drape (I-Drape).

In response to the COVID-19 pandemic, several protective barrier enclosures were developed to protect healthcare providers during airway manipulation. A certified registered nurse anesthetist (CRNA) created a barrier, the disposable intubation drape (I-Drape), that addressed limitations in range of motion. A nonrandomized, quasi-experimental design with repeated measures was used to evaluate I-Drape usability. CRNAs implemented I-Drape up to three times. Multilevel modeling was used to analyze the primary outcome: time (in seconds) to successful intubation. An online survey was used to evaluate secondary outcomes of interest: users' perceptions of features such as usability, visibility, and durability. We recruited 23 CRNAs as participants for 59 trials. Overall successful intubation and first-pass success rates were 96.6% and 93.2%, respectively. Time to successful intubation did not significantly decrease (ß = -9.16, P = 0.323) or differ significantly among types of laryngoscopy device and years of experience was not a significant factor. Overall, users favorably rated I-Drape with respect to usability, visibility, durability, and feature utility. This study demonstrated the functionality, success rate, and acceptability of I-Drape. I-Drape can be used safely and efficiently with any type of laryngoscopy device by providers with various experience levels.

Nurturing children's development through healthy eating and active living: Time for policies to support effective interventions in the context of responsive emotional support and early learning.

Fostering the growth, development, health, and wellbeing of children is a global priority. The early childhood period presents a critical window to influence lifelong trajectories, however urgent multisectoral action is needed to ensure that families are adequately supported to nurture their children's growth and development. With a shared vision to give every child the best start in life, thus helping them reach their full developmental potential, we have formed the International Healthy Eating Active Living Matters (HEALing Matters) Alliance. Together, we form a global network of academics and practitioners working across child health and development, and who are dedicated to improving health equity for children and their families. Our goal is to ensure that all families are free from structural inequality and oppression and are empowered to nurture their children's growth and development through healthy eating and physical activity within the context of responsive emotional support, safety and security, and opportunities for early learning. To date, there have been disparate approaches to promoting these objectives across the health, community service, and education sectors. The crucial importance of our collective work is to bring these priorities for early childhood together through multisectoral interventions, and in so doing tackle head on siloed approaches. In this Policy paper, we draw upon extensive research and call for collective action to promote equity and foster positive developmental trajectories for all children. We call for the delivery of evidence-based programs, policies, and services that are co-designed to meet the needs of all children and families and address structural and systemic inequalities. Moving beyond the "what" is needed to foster the best start to life for all children, we provide recommendations of "how" we can do this. Such collective impact will facilitate intergenerational progression that builds human capital in future generations.

Age suit simulation replicates in healthy young adults the functional challenges to balance experienced by older adults: an observational study.

Background: Age simulation can have a positive effect on empathic understanding and perception of ageing. However, there is limited evidence for its ability to replicate objectively the physical and functional challenges of ageing. Objective: To observe whether age suit simulation can replicate in healthy young adults the physical and physiological balance disturbance and falls risk experienced by older adults. Methodology: Healthy young adults aged 20-40 years (16 male) were recruited to the study using convenience sampling from a student population. Participants performed three validated balance tests-Functional Reach Test (FRT), Timed Up and Go (TUG) and Berg Balance Scale (BBS)-first without the age suit and then with the age suit, using a standardised protocol, following the same sequence. Results: 30 participants completed all tests. Statistically significant differences between without-age-suit and with-age-suit performance were recorded for FRT distance (p<0.000005), time taken to complete the TUG (p<0.0005) and BBS score (p<0.001). A comparison of participant scores with normative FRT and TUG scores identified that the suit had 'aged' the majority of participants to the normative values for older adults (60+), with some reaching the values for individuals aged 70-89. However, no scores achieved the values indicative of increased falls risk. Conclusions: The age suit is a valid educational tool that extends the value of age simulation beyond a more general empathising role, enabling those working with an older population to experience and understand the functional challenges to balance experienced by older adults as part of their training.

The Versajet water dissector: a new tool for tangential excision.

Goulian and Watson knives work well for tangential burn excision on large flat areas. They do not work well in small areas and in areas with a three-dimensional structure. The Versajet Hydrosurgery System (Smith and Nephew, Key Largo, FL) is a new waterjet-powered surgical tool designed for wound excision. The small size of the cutting nozzle and the ability to easily maneuver the water dissector into small spaces makes it a potentially useful tool for excision of burns of the eyelids, digits and web spaces. The Versajet Hydrosurgery System contains a power console that propels saline through a handheld cutting device. This stream of pressurized saline functions as a knife. We have used the Versajet for burn excision in 44 patients. Although there is a learning curve for both surgeons using and operating room staff setting up the device, the Versajet provides a relatively facile method for excision of challenging aesthetic and functional areas.

Problem-Based Learning (PBL): Conceptions and Approaches of Undergraduate Students of Nursing.

Objective: A study aimed at exploring the variation in conceptions of problem-based learning (PBL) held by undergraduate nursing students and their approaches to study in PBL in a pre-registration Bachelor of Nursing Course.Method: Students were asked to respond to four open ended questions which focussed on their experience of PBL in a particular subject. Data were analysed in two phases using a modified phenomenographic analysis. In the first phase a set of categories of description were developed from the student responses. In the second phase the individual responses were classified in terms of the categories. The paper will describe the approach to the analysis, the categories identified, the relationship between the categories and discuss the implications for further research and teaching.Results: The findings indicated that there was a substantial variation in the conceptions and approaches. The majority of students, however, held relatively unsophisticated conceptions of problem based learning which were related to relatively unsophisticated approaches to learning.Conclusion: Students participating in their first PBL subject generally reported unsophisticated conceptions of and approaches to learning which were not linked to professional practice outcomes. However, those completing the last PBL subject had recognised the link between participation in the process and the development of knowledge and skills for professional practice.

Assessment of mercury and selenium concentrations in captive bottlenose dolphin's (Tursiops truncatus) diet fish, blood, and tissue.

Concentrations of total mercury (Hg) and selenium (Se) were determined in diet fish and whole blood and tissue samples from seven bottlenose dolphins (Tursiops truncatus) housed at the National Aquarium Baltimore (NAB). In addition, concentrations of monomethylmercury (CH(3)Hg(+)) were determined in diet fish and dolphins' tissue samples. The data were compared with the values found in wild populations to better understand how the dietary Hg and Se uptake rates affect the Hg and Se levels in dolphins. The diet fish total Hg concentrations ranged between 14 and 47 ng g(-1) and were markedly lower than for similar fish found in Florida, South Carolina, and other aquaria. CH(3)Hg(+) accounted for 85 to 91% of the total Hg found in diet fish. The diet fish Se concentrations ranged between 270 and 800 ng g(-1), indicating excess molar concentrations of Se over Hg. The Hg concentration range in the blood of NAB dolphins was 27-117 ng g(-1) and the concentrations were about one order of magnitude and several factors lower than the concentrations found in the blood of wild bottlenose dolphins in Florida and in South Carolina, respectively. The total Hg and CH(3)Hg(+) in tissue samples were also significantly lower than the reported values obtained from wild populations of bottlenose dolphins. The differences in the Hg concentrations in the dolphins' blood may be due to the different levels of Hg atmospheric deposition in the area where the dolphins' diet fish were found. The Se concentration range in the blood of NAB dolphins was 221-297 ng g(-1) which was two factors lower than the values found in wild populations. The lower Hg levels, as well as higher Se:Hg molar ratios in the blood of NAB dolphins, suggest that NAB dolphins may be less susceptible to the potential neurotoxicity from the CH(3)Hg(+) in their blood.

Thar she blows! A novel method for DNA collection from cetacean blow.

BACKGROUND: Molecular tools are now widely used to address crucial management and conservation questions. To date, dart biopsying has been the most commonly used method for collecting genetic data from cetaceans; however, this method has some drawbacks. Dart biopsying is considered inappropriate for young animals and has recently come under scrutiny from ethical boards, conservationists, and the general public. Thus, identifying alternative genetic collection techniques for cetaceans remains a priority, especially for internationally protected species. METHODOLOGY/PRINCIPAL FINDINGS: In this study, we investigated whether blow-sampling, which involves collecting exhalations from the blowholes of cetaceans, could be developed as a new less invasive method for DNA collection. Our current methodology was developed using six bottlenose dolphins, Tursiops truncatus, housed at the National Aquarium, Baltimore (USA), from which we were able to collect both blow and blood samples. For all six individuals, we found that their mitochondrial and microsatellite DNA profile taken from blow, matched their corresponding mitochondrial and microsatellite DNA profile collected from blood. This indicates that blow-sampling is a viable alternative method for DNA collection. CONCLUSION/SIGNIFICANCE: In this study, we show that blow-sampling provides a viable and less invasive method for collection of genetic data, even for small cetaceans. In contrast to dart biopsying, the advantage of this method is that it capitalizes on the natural breathing behaviour of dolphins and can be applied to even very young dolphins. Both biopsy and blow-sampling require close proximity of the boat, but blow-sampling can be achieved when dolphins voluntarily bow-ride and involves no harmful contact.